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A study of validation of Stages of Changes on Spanish sample of inactive patients with inclusion of maximum oxygen uptake and physical activity self-report

Antonio I Cuesta-Vargas, F.J. Baron, A. Sanchez, I. Montoya, G. Grandes


Aims: The study aims to assess the Stage of Change (SoC) measure and algorithm in the context of existing and validated constructs including maximum oxygen uptake, self-reported physical activity (PA) and health-related quality of life on inactive patients conducted in primary care.

Methods: 4231 inactive patients were included from 56 collaborating general practices (GP) at 11 public primary healthcare centres in Spain were eligible to participate in this study. Assessment of SoC in PA, representing ordered categories of motivational readiness to change. The maximum oxygen uptake, the 7-day Physical Activity Recall and health-related quality of life measures were obtained using the SF-36 questionnaire. MANOVA test and Multiple Indicators and Multiple Causes (MIMIC) modelling were performed to evaluate the association between the 5 SoC groups and the dependent measures.

Results: The multivariate model demonstrated statistical significance (Pillai’s trace = 0.102, F48,16872 = 9.18,  p< .001) and the MIMIC model provided an excellent fit to the data (chi-square = 27.17; df  = 8; RMSEA = 0.024; CFI = 0.99).

Discussion: There is validity in the SoC framework among inactive patients beyond the transtheoretical model of change. This supports the usefulness of the SoC approach for the promotion of PA in interventions conducted in primary care and the enhancement health and wellbeing.


Health promotion validity, health-related quality of life, inactive persons, motivational readiness to change, physical activity, Stage of Change, wellbeing

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Konopak, J., Marquez, D., Hu, L., Elavsky, S., McAuley, E. & Kramer, A.F. (2004). Correlates of functional fitness in older adults. International Journal Behaviour Medicine 15 (4) 311–318.

Ruiz, J.R., Sui, X., Lobelo, F., Morrow, J.R. Jr., Jackson, A.W., Sjöström, M. & Blair, S.N. (2008). Association between muscular strength and mortality in men: Prospective cohort study. British Medical Journal 337, a439.

Ortega, F.B., Artero, E.G., Ruiz, J.R., España-Romero, V., Jiménez-Pavón, D., Vicente-Rodriguez, G., Moreno, L.A., Manios, Y., Béghin, L., Ottevaere, C., Ciarapica, D., Sarri, K., Dietrich, S., Blair, S.N., Kersting, M., Molnar, D., González-Gross, M., Gutiérrez, A., Sjöström, M. & Castillo, M.J.; HELENA study. (2011). Physical fitness levels among European adolescents: The HELENA study. British Journal Sports Medicine 45 (1) 20-29.

Grandes, G., Sanchez, A., Montoya, I., Sanchez-Pinilla, R.O. & Torcal, J., for the PEPAF Group. (2011). Two-Year Longitudinal Analysis of a Cluster Randomized Trial of Physical Activity Promotion by General Practitioners. PLoS One 6 (3) e18363.

Haskell, W. L., Lee, I.M., Pate, R.R., Powell, K.E., Blair, S.N., Franklin, B.A., Macera, C.A., Thompson P.D. & Bauman A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise 39 (8) 1423–1434.

U.S. Department of Health and Human Services: Office of Disease Prevention and Health Promotion. (2000). Healthy People 2010. NASNewsletter 15 (3) 3.

Estabrooks, P.A., Glasgow, R.E. & Dzewaltowski, D.A. (2003). Physical activity promotion through primary care. Journal of the American Medical Association 289 (22) 2913–2916.

Petrella, R.J., Koval, J.J., Cunningham, D.A., & Paterson, D.H. (2003). Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. American Journal of Preventive Medicine 24 (4) 316-322.

Wee, C.C. (2001). Physical activity counseling in primary care: the challenge of effecting behavioral change. Journal of the American Medical Association 286 (6) 717-719.

National Institute for Health and Clinical Excellence. NICE public health intervention guidance no 2 (2006) – Four commonly used methods to increase physical activity: brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. Available: Accessed 2010 Aug 13.

Breckon, J.D., & Johnston, L.H. (2009). Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review. Health Education Behaviour 36, 829-845.

Bridle, C., Riemsma, R.P., Pattenden, J., Sowden, A.J., Mather, L., Watt, I.S. & Walker, A. (2005). Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychology & Health 20 (3) 283-301.

Plotnikoff, R.C., Hotz, S.B., Birkett, N.J. & Courneya, K.S. (2001). Exercise and the transtheoretical model: a longitudinal test of a population sample. Preventive Medicine 33 (5) 441–452.

Reed, G.R., Velicer, W.F., Prochaska, J.O., Rossi, J.S. & Marcus, B.H. (1997). What makes a good staging algorithm: examples from regular exercise. American Journal of Health Promotion 12 (1) 57-66.

Nigg, C. (2002). Physical activity assessment in population-based interventions: A stage approach. In: Physical activity assessments for health-related research, (pp. 227–240). G. Welk (Ed.). Champaign, IL: Human Kinetics.

Balady, G., Berra, K. & Golding, L. (2000). ACSM’s guidelines for exercise testing and prescription. Baltimore, Lippincott Williams & Wilkins.

Alonso, J., Regidor, E., Barrio, G., Prieto, L., Rodríguez, C. & de la Fuente, L. (1998). Population reference values of the Spanish version of the Health Questionnaire SF-36. Medicina Clínica 111 (11) 410-416.

Grandes, G., Sánchez, A., Torcal, J., Sánchez-Pinilla, R.O., Lizarraga, K. & Serra, J. (2008). Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change. BMC Public Health 8, 172.

Grandes, G., Sanchez, A., Sanchez-Pinilla, R.O., Torcal, J., Montoya, I., Lizarraga, K. & Serra, J. (2009). Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Archives Internal Medicine 169, 694-701.

Garatachea, N., Cavalcanti, E., García-López, D., González-Gallego, J. & de Paz, J.A. (2007). Estimation of energy expenditure in healthy adults from the YMCA submaximal cycle ergometer Test. Evaluation Health Professions 30 (2) 138-149.

Crocker, P.R., Bailey, D.A., Faulkner, R.A., Kowalski, K.C. & McGrath, R. (1997). Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Medicine and Science in Sports and Exercise 29 (10) 1344-1349.

Vilagut, G., Ferrer, M., Rajmil, L., Rebollo, P., Permanyer-Miralda, G., Quintana, J.M., Santed, R., Valderas, J.M., Ribera, A., Domingo-Salvany, A. & Alonso, J. (2005) The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments. Gaceta Sanitaria 19 (2) 135-150.

Jöreskog, K. & Sörbom, D. (2007). LISREL 8.80. Chicago, IL: Scientific Software International, Inc.

Schumacker, R.E. & Lomax, R.G. (2004). A beginner’s guide to structural equation modeling. New York. Routledge.

McDonald, R.P. & Marsh, H.W. (1990). Choosing a multivariate model: Noncentrality and goodness of fit. Psychological Bulletin 107, 247–255.

Booth, M.L., Macaskill, P., Owen, N., Oldenburg, B., Marcus, B.H. & Bauman, A. (1993). Population prevalence and correlates of stages of change in physical activity. Health Education Quarterly 20 (3) 431–440.



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